Organization
WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILSON D GOMER MD (PRESIDENT)
(909) 802-9374
Entity
Organization
Contact information
Practice address
1800 WESTERN AVE STE 103, SAN BERNARDINO, CA 92411
(909) 887-7427
(909) 887-7430
Mailing address
1800 WESTERN AVE STE 103, SAN BERNARDINO, CA 92411-1352
(909) 887-7427
(909) 887-7430
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
A50690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A506900
—
CA
Enumeration date
02/21/2018
Last updated
06/06/2018
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